ANSWER
Chest pain should not be ignored. However, you should be aware that there are numerous possible causes. It is frequently associated with the heart. However, chest pain can also be caused by problems with your lungs, esophagus, muscles, ribs, or nerves. Some of these conditions are serious and even fatal. Others, however, are not. If you have unexplained chest pain, the only way to find out what’s causing it is to see a doctor.

From your neck to your upper abdomen, you may experience chest pain. Chest pain can be caused by a variety of factors, including:

Sharp \sDull \sBurning
Aching \sStabbing
A feeling of being squeezed, squeezed, or crushed
The following are some of the most common causes of chest pain.

Heart Issues
These are common causes of heart problems:

Coronary artery disease, abbreviated as CAD. This is a blockage in the heart’s blood vessels, which reduces blood flow and oxygen to the heart muscle. Angina is a type of pain caused by this. It is a symptom of heart disease, but it usually does not result in permanent heart damage. It is, however, a warning sign that you are at risk of having a heart attack in the future. The pain in your chest may spread to your arm, shoulder, jaw, or back. It could feel like pressure or squeezing. Exercise, excitement, or emotional distress can all cause angina, which can be relieved by rest.
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Acute myocardial infarction (heart attack). This decrease in blood flow through the heart’s blood vessels results in the death of heart muscle cells. A heart attack, similar to angina chest pain, is usually a more severe, crushing pain in the center or left side of the chest that is not relieved by rest. The pain may be accompanied by sweating, nausea, shortness of breath, or severe weakness.

Myocarditis. In addition to chest pain, this heart muscle inflammation can cause fever, fatigue, rapid heartbeat, and breathing difficulties. Although there is no blockage, myocarditis symptoms can be similar to a heart attack.

Pericarditis. This is an infection or inflammation of the sac surrounding the heart. It can cause pain that is similar to angina. However, it frequently causes sharp, constant pain along the upper neck and shoulder muscles. It can get worse when you breathe, swallow food, or lie on your back.

Cardiomyopathy caused by hypertrophy. This genetic disorder causes the heart muscle to thicken abnormally. This can sometimes cause problems with blood flow out of the heart. Exercise frequently causes chest pain and shortness of breath. Heart failure can develop over time as the heart muscle thickens. The heart has to work harder to pump blood as a result. This type of cardiomyopathy can cause dizziness, lightheadedness, fainting, other symptoms, and chest pain.

Prolapse of the mitral valve. Mitral valve prolapse is a heart condition in which a valve fails to close properly. Mitral valve prolapse has been linked to various symptoms, including chest pain, palpitations, and dizziness, but it can also be asymptomatic, especially if the prolapse is mild.

A dissection of the coronary arteries. Many factors can contribute to developing this rare but fatal condition, which occurs when a tear develops in the coronary artery. It can cause a tearing or ripping sensation in the neck, back, or abdomen and sudden, severe pain.

Lung Issues
These are some of the most common causes of chest pain:

Pleuritis. This is an inflammation or irritation of the lungs and chest lining, also known as pleurisy. When you breathe, cough, or sneeze, you most likely experience sharp pain. Bacterial or viral infections, pulmonary embolism, and pneumothorax are the most common causes of pleuritic chest pain. Rheumatoid arthritis, lupus, and cancer are some less common causes.

Pneumonia or abscess of the lungs. Pleuritic and other types of chest pain, such as a deep chest ache, can be caused by these lung infections. Pneumonia frequently manifests itself abruptly, causing fever, chills, cough, and pus coughing up from the respiratory tract.

Embolism of the lungs. A blood clot that travels through the bloodstream and becomes lodged in the lungs can cause acute pleuritis, difficulty breathing, and a rapid heartbeat. It may also result in fever and shock. Pulmonary embolism is more likely after deep vein thrombosis, being immobile for several days after surgery, or as a cancer complication.

Pneumothorax. Pneumothorax occurs when a portion of the lung collapses, allowing air into the chest cavity and is frequently caused by a chest injury. This can also result in pain that worsens when you breathe and other symptoms like low blood pressure.

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Hypertension of the lungs. This abnormally high blood pressure in the lung arteries causes the right side of the heart to work too hard, causing chest pain similar to angina.

Asthma. Asthma is an inflammatory disorder of the airways that causes shortness of breath, wheezing, coughing, and sometimes chest pain.

COPD. This includes one or more of the following diseases: emphysema, chronic bronchitis, and chronic obstructive pulmonary disease. The disease restricts airflow by shrinking and damaging the airways that transport gases and air to and from your lungs and the tiny air sacs (alveoli) that transport oxygen to your bloodstream and remove carbon dioxide. The most common cause is smoking.

Gastrointestinal Issues
Chest pain can also be caused by gastrointestinal issues, which include:

GERD is an abbreviation for gastroesophageal reflux disease (GERD). GERD, also known as acid reflux, occurs when stomach contents reflux into the throat. Heartburn is caused by a sour taste in the mouth and a burning sensation in the chest or throat. Obesity, smoking, pregnancy, and spicy or fatty foods can all cause acid reflux. Heart pain, acid reflux, and heartburn feel similar because the heart and esophagus are close together and share a nerve network.

Disorders of esophageal contraction. Spasms (uncoordinated muscle contractions) and high-pressure contractions (nutcracker esophagus) are esophageal problems that can cause chest pain.

Hypersensitivity of the esophagus. This happens when the esophagus becomes extremely painful at the slightest pressure change or acid exposure. This sensitivity has an unknown cause.

Perforation or rupture of the esophagus. A sudden, severe chest pain following vomiting or an esophageal procedure may indicate an esophageal rupture.

Ulcers in the stomach. These painful sores in the stomach or the first part of the small intestine may cause a vague, recurring discomfort. Pain that gets better when you eat or take antacids is more common in people who smoke, drink a lot of alcohol, or take painkillers like aspirin or NSAIDs.

Hernia hiatal. This common problem occurs after eating when the top of the stomach pushes into the lower chest. This frequently results in reflux symptoms such as heartburn or chest pain. When you lie down, the pain tends to worsen.

Pancreatitis. If you have pain in the lower chest that is worse when you lie flat and better when you lean forward, you may have pancreatitis.

Gallbladder issues. Do you feel fullness or pain in your right lower chest or right upper abdomen after eating a fatty meal? If this is the case, your chest pain could be caused by a gallbladder problem.

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Problems with the bones, muscles, or nerves
Overuse or an injury to the chest area from a fall or accident can cause chest pain. Viruses can also cause pain in the chest. Other possible causes of chest pain include:

Rib issues. A broken rib’s pain may worsen with deep breathing or coughing. It is frequently confined to one area and may be painful to press. Inflammation can also occur where the ribs meet the breastbone.

Muscle tension. A strong cough can injure or inflame the muscles and tendons between the ribs, resulting in chest pain. The pain usually lasts and worsens with activity.

Shingles. Shingles, caused by the varicella-zoster virus, can cause a sharp, band-like pain before a rash appears several days later.

Other Possible Sources of Chest Pain
Anxiety and panic attacks are other potential source of chest pain. Dizziness, shortness of breath, palpitations, tingling sensations, and trembling are all possible symptoms.

When Should You See a Doctor for Chest Pain?
When in doubt, consult your doctor about any chest pain, especially if it occurs suddenly or is not relieved by anti-inflammatory medications or other self-care measures such as dietary changes.

If you have any of the following symptoms in addition to chest pain, dial 911:

An unexpected sensation of pressure, squeezing, tightness, or crushing beneath your breastbone
Pain in your chest that spreads to your jaw left arm, or back
Sudden, sharp chest pain accompanied by shortness of breath, particularly after a prolonged period of inactivity
Nausea, dizziness, rapid heart rate or rapid breathing, confusion, ashen color, or excessive sweating are all symptoms of a heart condition.
Extremely low blood pressure or heart rate
If you experience any of the following symptoms, contact your doctor:

Fever chills, or coughing up yellow-green mucus
Problems swallowing
Severe chest pain that does not go away
QUESTION
A 52-year-old male patient who is a house painter presents to the office reporting chronic fatigue and “mild” chest pain. When he is painting, chest pain is relieved after taking a break. He reports that the pain usually lasts 5 minutes or less and occasionally spreads to his left arm before subsiding. The patient was last seen 3 years ago by you, and you recommended diet changes to manage mild hyperlipidemia, but the patient has gained 30 pounds since that time. The patient’s medical history includes anxiety, vasectomy, cholecystectomy, and mild hyperlipidemia. The patient does not smoke or use other tobacco or nicotine products. The patient cares for his wife, who has multiple sclerosis and requires 24-hour care. His daughter and grandson also live with the patient. His daughter assists with the care of his wife, and his job is the major source of income for the family. The initial vital signs are: blood pressure 158/78, heart rate 87, respiratory rate 20, and body mass index 32. As part of the diagnostic work-up, an ECG, lipid levels, cardiac enzymes, and C-reactive protein (CRP) are ordered. The patient reports that he does not have time to “be sick” and says that he needs to take care of everything during this visit so he can return to work and care for his wife. Discuss the following:

What additional information should you obtain about the pain the patient is experiencing?
What additional physical assessment needs to be performed with this patient?
What considerations are important to remember if the patient’s CRP level is elevated?
What differential diagnoses should be considered for the patient?
What patient teaching will be incorporated into the visit to modify the patient’s risk factors?
How will you respond to the patient’s statement that he does not have time to “be sick” and needs to take care of everything during this visit?
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